2011 Spring Image of the Issue
Heart & Vascular Institute Physician eNewsletter - Spring 2011
With a non-contrast Computed Tomography (CT) scan, physicians can get a clearer picture of whether a patient’s risk factors such as high blood pressure, elevated cholesterol levels or high body mass index should be treated more aggressively with a non-contrast Computed Tomography (CT) scan. A low-radiation dose non-contrast CT can show calcium deposits in the coronary arteries, the aorta or the aortic root, and signal the need for aggressive medical therapy with cholesterol lowering medications—or basic maintenance, such as a stringent exercise program that will reverse risk for major adverse cardiac events.
"The non-contrast CT is a screening test that is ideal for physicians in preventive medicine who serve as the front line,"says Balaji Tamarappoo, MD, PhD, associate staff, cardiovascular medicine, Cleveland Clinic Miller Family Heart & Vascular Institute.
Consider this patient scenario:
A 50-year-old male presents with high cholesterol, but is otherwise healthy. A non-contrast CT scan can help a physician "see"behind the numbers that the cholesterol test presents. "If the physician finds calcium in one or more coronary arteries, he or she can show that image to the patient to reinforce that the increased circulating cholesterol is now affecting the patient’s coronary arteries,"he says. From there, the physician can make more informed decisions about appropriate treatment and prescribing life-style modification.
Image A shows calcium in the left main coronary artery, which puts this patient at high risk for a cardiac event, such as heart attack or sudden cardiac death. Plaque in the left main is a serious red flag.
Image B shows calcium in the right coronary artery, whereas this may not be as serious as a left main lesion the presence of calcium still puts this patient at an increased risk.
Image C depicts calcium in the aortic root—a region that should not be overlooked in a non-contrast CT scan.
The non-contrast CT would not be conducted on a 75-year-old patient with chest pain, high blood pressure and diabetes. "You do not do this test if you already know the patient is high-risk,"Dr. Tamarappoo says. "This test is for patients who fall in that intermediate risk category.”
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